Incompatible red blood cell transfusion for hemolytic disease of the fetus and newborn secondary to anti-U: A case report

BackgroundHemolytic disease of the fetus and newborn (HDFN) is a challenging condition that may necessitate the need for intrauterine or neonatal transfusion. The ability to provide compatible blood depends on antibody identification and antigen prevalence. We describe the case of a newborn that was affected by HDFN secondary to a high-prevalence antigen of unknown specificity. Study Design and MethodsA 29-year-old mother underwent emergency cesarean section for fetal distress. The newborn had severe anemia and hyperbilirubinemia. Antibody screening and identification on maternal plasma revealed pan reactivity with negative autocontrol. The cord sample had the same pattern with positive Direct Antiglobulin Test. Incompatible group O red blood cells were transfused to the newborn with no complications. ResultsTesting the maternal sample at a reference laboratory revealed the presence of anti-U at a high titer. DiscussionIn life-threatening conditions, it may be necessary to transfuse incompatible units. In patients who require transfusion in the presence of an identified antibody against a high-prevalence antigen, sources for rare blood should be explored. These include autologous donations for adults, collecting blood from relatives (including mothers), and fresh or frozen units from rare donors through rare donor registries.

Automated summary

This article describes a case of a newborn with hemolytic disease of the fetus and newborn (HDFN) due to a high-prevalence antigen of unknown specificity, requiring a blood transfusion. Antibody screening and identification in the mother showed pan reactivity, and the cord sample also showed positive results. Incompatible group O red blood cells were transfused to the newborn without complications.